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DESCRIPTION
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th th14 to 16 November , 2014
th39 National Conference of
AOMSI 2014Venue: Cidade de Goa, Vainguinim Valley, Goa
Registration Form
NAME
COLLEGE
ADDRESS
DATE OF BIRTH SEX
AOMSI MEMBERSHIP NO
Registration Details ( Select Any One )th st th Category Up to 15 Feb. 2014 Up to 31 Mar. 2014 Up to 30 Sep. 2014
Residential Delegate * ` 18500 ` 20000 ` 22000
Non-Residential Delegate ` 7000 ` 7500 ` 8500
Non-Residential PG Student ` 5500 ` 6000 ` 6000
Residential PG Student # ` 11500 ` 12000 ` 13500
Accompanying Person ` 6500 ` 7000 ` 7500
Overseas Delegate ** $ 570 $ 670 $ 725
Overseas Trainee ** $ 480 $ 570 $ 670
stFrom 1 Oct.2014
Not Available
` 10000
` 7000
Not Available
` 8000
Not Available
Not Available
Course details Registration Fee
Implants Basic / Advanced ̀ 1500
Trauma ` 1500
Orthognathic Surgery ` 1500
Advances in Oral Cancer Management ` 1500
Advanced Botulinum A and Dermal Filler course ` 3000 ( Limited Seats )
3-D Virtual Planning for Orthognathic Surgery ` 3000 ( Limited Seats )
Maxillofacial & Reconstructive Surgery Cadaveric course ` 3000 ( Limited Seats )
Pre-Conference Course ( Select Any One )
All / any pre-conference courses may be cancelled / changed depending on the registration
All Abstracts to be uploaded on the website www.aomsicongoa.in after the registration is completed
Please visit www.aomsicongoa.in to register and make payment online.
* Residential Registration is strictly on a twin sharing basis for 3 Nights from November 14 to November 17, 2014.
# PG Students opting for Residential Registration will be accommodated in a suitable arrangement on twin / triple sharing basis.
** Overseas Registration Fees are inclusive of Accommodation for the duration of the Conference.
Accompanying Persons to pay the same amount as Delegate for Residential Registration.
All Residential Delegate Registrations shall be accommodated at the venue hotel strictly subject to availability of rooms.
Indian Delegates & Students who are NOT members of AOMSI should pay Rs. 1500/- more for any category of Registration they select.
This is to certify that Dr is a bonafide post graduate
student of
presently studying in I/II/III year of MDS.
Stamp and Signature of the HOD
Bonafide Certificate
Amount ` Cheque Dated DD / Cheque No.
Bank
Mobile No.
Payment Details
Demand Draft / At Par Cheque to be drawn in favour of “ 39AOMSICONF ” payable at Panjim, Goa.Please send your duly filled form along with payment to the Conference Secretariat.
Conference Secretariat
Department of Oral & Maxilofacial SurgeryGoa Dental College and Hospital
Rajiv Gandhi Medical Complex
Bambolim, Goa 403202
Email: [email protected]
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